PELVIC ORGAN PROLAPSE
Pelvic Organ Prolapse (POP) is basically a hernia of the vaginal walls allowing for the bowel, bladder, and/or uterus to bulge into the vagina. POP can be painful but typically women will complain of pressure rather than pain, along with other symptoms including the following:
- “Falling out feeling”/downward pressure
- Pain with intercourse
- Difficulty emptying bladder/urination (resulting in double-voiding or frequent urination)
- Difficulty emptying bowel/defecation (resulting in internal splinting or pushing near anus to facilitate evacuation of stool)
- Incontinence may be present but is not necessarily a sign of prolapse
There are 4 stages of prolapse (1=mild to 4=severe) and it is possible to experience a range in severity of symptoms that do not necessarily coincide with the level of prolapse. Typically a grade 3 or 4 depending on symptoms and quality of life is considered to be a surgical case. Grades 1 and 2 can usually improve with physical therapy. Strengthening of the pelvic floor muscles (Kegels) are typically indicated for POP however it is very important to see a pelvic floor physical therapist to ensure you are performing Kegels correctly. Treatment for Bowel and Bladder Retraining are also very beneficial for treating the symptoms of POP. In addition, see treatment under Incomplete Emptying/Post-Void Dribble for self-management strategies.
Exercise Do’s and Don’ts for POP:
- Always exhale with effort. Any exercise that is so strenuous you have to hold your breath is to intense and will increase intra-abdominal pressure causing an overload on the pelvic floor increasing risk of further prolapse.
- Avoid abdominal exercises including sit-ups, crunches, resisted or weight loaded abdominal exercises, and any abdominal exercises where you are lifting one or both legs (teaser, bicycle, ball leg raising, hang leg raising, etc.). Planks, hand planks, and other stability type abdominal exercises are okay as long as you can breathe through it and both feet are grounded during the exercise.
- Running and other high-impact activity will overload and eventually weaken the pelvic floor muscles and increase risk of prolapse. Walking or cardio machines that are low impact are a better option.
It is important to have a pelvic floor physical therapist assess your pelvic floor to ensure you are properly performing kegels as well as have proper breathing technique and form during all exercises. ANY exercise can increase your POP if you are performing it incorrectly and bearing down through your pelvic floor without awareness.